Workplace nutrition and physical activity promotion at Liverpool Hospital

Influencing health behaviours

Workplace nutrition and physical activity promotion at Liverpool Hospital Isabel Hess, Janelle Borg and Chris Rissel

Introduction The workplace is an efficient way of reaching large numbers of adults and is a good setting for health promotion programs.1-5 The Australian Government lists healthy living programs in the workplace as an objective in the National Partnership Agreement on Preventive Health3 and the World Health Organisation and the World Economic Forum strongly support health promotion in the workplace.4 In addition, the workplace is specifically identified as a key action area for increasing physical activity levels of Australians by the National Heart Foundation of Australia.5 Workplace programs to increase physical activity, promoting healthy eating or both are effective.6-9 Workplace interventions targeting physical activity are successful when pedometers were part of the study design,10,11 especially when combined with a daily step goal such as 10,000 steps.12 Internet-based motivational messages or weekly e-mail tips have also been shown to increase physical activity either alone13 or with pedometers.10 Further, programs were more successful if they promoted incidental physical activity within and around the workplace,6,14 promoted active transport (walking, cycling and using public transport) to and from work,14,15 and incorporated

social support into the intervention.6,14 Peer support is a critical element of effective and sustainable physical activity programs.7 Workplace interventions targeting healthy eating are more successful if they include environmental changes.6,16 This was confirmed by a recent review where interventions targeting nutrition were most effective when they were multi-component interventions that included physical activity as well as nutrition, and incorporated nutrition education and promotional strategies at point-of-purchase.7 To our knowledge, there are no workplace interventions that have used multiple individual and environmental strategies to increase health behaviours. Further, there appears to be few studies of healthy eating and physical activity interventions targeting the hospital workforce. Therefore, the Health Promotion Service of Sydney South West Area Health Service (SSWAHS) developed the Liverpool Hospital TEAM Challenge (TEAM = Take steps, Eat well, And Measure up). Part of this program was based on the Rockhampton approach of aiming to reach 10,000 steps per day using a pedometer.17,18 The program was further modified to use a team-based approach to provide

Abstract Issue addressed: The workplace is an effective way of reaching large numbers of adults during working hours, and increasing physical activity, promoting healthy eating or both. This paper evaluates the effectiveness of a workplace intervention in a hospital setting in Australia. Methods: A 12-week program was conducted with 399 employees of Liverpool Hospital, NSW, to increase physical activity and healthy eating. Participants received a pedometer, healthy cookbook, water bottle, sandwich container and Measure Up campaign resources. A web-based survey was completed at baseline and follow up. Results: Sixty-six per cent of participants completed the follow-up survey. Those that did not complete the follow-up evaluation were not significantly different to completers. Respondents reported a significant increase in median minutes walked to 200 minutes and in vigorous physical activity to 85 minutes over the previous week. Participants consuming adequate fruit and vegetable per day increased by 24.7% and 22.7%, respectively. More participants also consumed breakfast on seven days of the week and consumed one or more litres of water per day. Conclusions: The intervention was successful for the participants. With some improvements to processes, we encourage further similar programs with the health sector workforce. Key words: physical activity, nutrition, workplace, health promotion, hospital, pedometer Health Promotion Journal of Australia 2011; 22: 44-50

So what? This paper demonstrates the effectiveness of a health promotion program in a hospital workplace setting. Similar programs should be developed for healthcare and hospital staff, focusing on engaging less physically active and male employees.

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Health Promotion Journal of Australia 2011: 22(1)

Influencing health behaviours

peer support and help motivate participants to increase physical activity and healthy eating. The aim of this study was to evaluate the impact of the TEAM Challenge to determine whether it is an effective intervention for a hospital setting.

Workplace nutrition and physical activity

After completion of the challenge, prizes were awarded to the teams who took the most steps and ate the healthiest. All participants were asked to complete an online follow-up questionnaire. Initial and follow-up questionnaires

Methods Recruitment of participants Participants were employees of Liverpool Hospital and were recruited over a two-week period through internal communication channels. Participants were invited to join the Liverpool Hospital Team Challenge as an individual or a team of five people. People who signed up as individuals were later assigned to a team. Individuals were recruited on a first come, first served basis, as the program resources allowed for a maximum number of 400 participants. Eligible participants had access to the Internet and e-mail, spoke English and had no physical limitations. A study information sheet was e-mailed to all eligible participants with a weblink to a baseline survey to be completed online. This information sheet explained that participation was voluntary, all individual information would be confidential, and that participants could withdraw at any stage. Consent to participate was demonstrated by the voluntary completion of the on-line baseline questionnaire. Ethical procedures followed were consistent with guidelines recommended by the NHMRC. On completed survey completion, the participants were notified by e-mail that they were successfully registered.

Intervention The intervention ran for a total of 12 weeks. All participants were provided with a registration pack, that included: • • • • • • •

information leaflet about how the challenge works; pedometer; healthy eating log book; water bottle; sandwich box; ‘Healthy Food Fast’ cookbook; and Measure Up campaign resources.

The evaluation design was a simple pre and post-test design, with online questionnaires completed at baseline and at follow-up. Both questionnaires were designed using the Internet site Survey Monkey.20 The questionnaires aimed to determine whether there were any changes in health behaviours and sought participants’ opinions about the perceived usefulness of the intervention strategies. Physical activity measures The Active Australia (AA) questionnaire, which has good criterion validity, was used to assess physical activity behaviours.21 The main outcome measures included past week minutes walking plus the number of times during the past week the participant walked continuously, for at least 10 minutes for exercise, recreation or to get to/from places, and the total minutes spent participating in such walking. Additional AA questions measured the frequency and duration of moderate and vigorous physical activities (MVPA) and assessed the total minutes and sessions accrued in the past week through regular walking and MVPA. The total minutes of physical activity per week were calculated by adding minutes in the last week spent walking (continuously for at least 10 minutes), plus minutes doing moderate physical activity, plus two times the minutes doing vigorous physical activity. Participants were classified as ‘active’ when reaching the physical activity goal of ≥150 min per week. Other measures Health-related behaviour was assessed, including smoking status, self-rated health, physical activity at work, self-rated physical activity level, and height and weight to determine BMI. Four questions about fruit and vegetable consumption, soft drink and breakfast cereal consumption were used from the NSW Health Survey,22 as well as socio-demographics such as age, gender, education, ethnicity and occupation. Participants were then classified into three different occupational groups:

Participants were required to wear a pedometer and record their daily steps for 12 weeks on the 10,000 steps website.19 Participants were also required to record their daily consumption of fruit, vegetable, water and healthy breakfast in the healthy eating log book during a four-week period, from week five to week eight (for feasibility purposes). Participants’ steps and dietary information were added to produce a team score, which was displayed weekly in the staff canteen.

• nurses and doctors;

Weekly walks were led by Health Promotion staff during the challenge and were available for all staff at Liverpool Hospital. Other motivational and environmental strategies implemented during the intervention included:

1. All participants (n=399).

• posters identifying local walking routes and healthy messages; • weekly motivational e-mails;

3. Comparison of the three occupational group datasets (nurses and doctors versus allied health and other professionals; nurses and doctors versus administrative services and non-professional

• ‘footprints’ directing people to use the stairs; and

• allied health and other professionals; and • administrative services and non-professional support services. Questions were included at the end of the follow-up questionnaire for the process evaluation. Statistical analysis: Using SPSS (version 17.0.3), the following datasets were analysed: 2. Participants who completed the challenge (n=264) versus participants who dropped out of the challenge (n=135) (participants who did not complete the follow-up survey).

• healthy messages on pay slips.

Health Promotion Journal of Australia 2011: 22(1 )

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Article

support services; and allied health and other professionals versus administrative and non-professional support services). 4. Before and after challenge datasets from the participants who completed the challenge (n=264). 5. A subset of active participants (≥150 min physical activity per week at baseline) and inactive participants (